腔镜辅助小切口腹股沟淋巴结切除术治疗外阴癌  

Endoscopic-assisted Small Incision Inguinal Lymphadenectomy for Vulvar Carcinoma

作　　者：张豪锋[1] 张军[1] 贺建业[2] 

机构地区：[1]首都医科大学附属北京安贞医院妇产科,北京100029 [2]首都医科大学附属北京安贞医院普外科,北京100029

出　　处：《中国微创外科杂志》2017年第3期220-223,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腔镜辅助小切口(3 cm)腹股沟淋巴结切除术治疗外阴癌的可行性、安全性及临床效果。方法2013年9月~2015年12月,对6例外阴癌实施外阴局部广泛切除及腔镜辅助小切口腹股沟淋巴结切除术,其中单侧淋巴结清扫2例,双侧4例。腹股沟处做小切口(3 cm),提起皮肤边缘,逐渐分离皮下组织,暴露术野,在腔镜下行腹股沟淋巴结切除术。结果 6例均成功完成手术,未中转开腹手术,未出现术中副损伤。腹股沟淋巴结切除手术时间60~90(78.3±14.7)min,术中出血量20~40(31.6±9.8)ml。术后病理回报每侧切除淋巴结3~13(8.7±3.0)个。病理诊断均为外阴鳞状细胞癌。FIGO分期ⅠB期2例,Ⅱ期4例。术后切口拆线时间7~9(7.8±0.7)d。随访3~12(6.5±4.4)月,无术后切口裂开或延迟愈合、腹股沟区皮肤坏死、下肢淋巴水肿等手术并发症,未出现肿瘤复发和转移。结论外阴局部广泛切除联合腔镜辅助小切口腹股沟淋巴结切除术治疗外阴癌效果确切,安全可行,并发症少,恢复快,可保证手术根治性效果。Objective To explore the safety and feasibility of endoscopic-assisted inguinal lymphadenectomy via a small incision（3 cm） for vulvar carcinoma. Methods From September 2013 to December 2015,local wide excision and endoscopicassisted inguinal lymphadenectomy via a 3-cm incision was performed to treat vulvar carcinoma in 6 women. There were 2 cases of unilateral operation and 4 cases of bilateral operations. A small incision（3 cm） was made in the groin. The skin edge was lifted to separate subcutaneous tissue and obtain a surgical exposure. Then endoscopic inguinal lymphadenectomy was conducted. Results The surgeries were successful in all the 6 patients,with no conversion to open surgery or intraoperative secondary injury. The operation time of inguinal lymphadenectomy was 60-90 min（ 78. 3 ± 14. 7 min）,and the blood loss was 20-40 ml（31. 6 ± 9. 8 ml）. The number of lymph nodes desected was 3-13（8. 7 ± 3. 0） in each side. Pathological examinations showed squamous cell carcinoma.The FIGO staging showed 2 cases of stage Ⅰ B and 4 cases of stage Ⅱ. The postoperative stitches removal time was 7-9 d（7. 8 ± 0. 7d）. No surgical complications,such as incision disruption,delayed healing,inguinal skin necrosis,or lower extremity lymphedema,were recorded during a 3-12 months（6. 5 ± 4. 4 months） of follow-up. No tumor recurrence or metastasis was found. Conclusions Endoscopic-assisted inguinal lymphadenectomy via mall incision in the treatment of vulvar carcinoma is effect,safe and feasible. It achieves radical effects.

关 键 词：腔镜辅助手术 小切口 外阴癌 腹股沟淋巴结切除术 

分 类 号：R737.35[医药卫生—肿瘤]